What are the symptoms of prostate cancer? A comprehensive guide to differentiate the signs.

Throughout the year, more than 29,000 men in Spain receive a diagnosis of prostate cancer and join the nearly 5 million who have the same disease in the world. Most will be cured or will live many yearsalthough the tumor does not disappear, but a minority of those affected will die (close to 6,000 in our country in the year 2021), and if they are known and more or less youthsthe impact is great because it makes true that “it can touch you”, and for example, now it is meets one year after the death, at the age of 61, of Javier ImbrodaMinister of Education and Sports of the Junta de Andalucía and former national basketball coach.

Men should advance their check-ups at 45 if they have a father or brother diagnosed with prostate cancer before the age of 65

And it is necessary to bear in mind that, although 90% of cases are diagnosed after the age of 65prostate cancer it is not a disease of old, and that’s why the Spanish Association of Urology recommended to all men have urological check-ups starting at age 50, especially if they have urinary symptoms, and advance them to 45 for men who have a father or brother diagnosed with prostate cancer before the age of 65. This very simple recommendation does not, however, have the same follow-up as, for example, breast cancer screening programs.

In fact, Dr. José Manuel Cózar, from the University of Granada, confesses that “urologists want to reproduce the successful model early detection of breast pathology in women”, but he believes that deep down there is the fact that “many men they don’t want to go to the urologist because they don’t want a rectal examination. Many jokes are made on this subject, but jokes can kill”. Perhaps this excuse is losing strength, since the usefulness of digital rectal examination for early identification of prostate cancer is more than controversial, as was made clear at the last European Congress of Urology.

The symptoms

Early stage prostate cancer often does not give signswarns the American Society of Clinical Oncology in his web page. Despite this, there are certain symptoms that can be revealing:

• Frequent urination.
• Weak or interrupted flow of urine, or the need to strain to empty the bladder.
• Urgency to urinate frequently at night.
• Blood in the urine.
• Blood in the seminal fluid.
• New-onset erectile dysfunction.
• Pain or burning when urinating.
• Painful ejaculation.
• Discomfort or pain when sitting caused by a enlargement of the prostate.

However, these symptoms are common to the benign prostatic hyperplasia (enlarged prostate), which is a natural process that appears around the age of 50. “From the age of 70 or 80, all men have BPH.”

How do you get out of doubt?

Through a blood test is done to determine PSA (Prostate Specific Antigen), a biomarker whose usefulness has been controversial at times (there are some conditions that can increase its value and erroneously suggest the presence of cancer, such as prostatitis or hyperplasia). Still, “everything the world accepts which is a boon for increased survival from prostate cancer. Since the PSA emerged, mortality from prostate cancer has decreased and no one disputes its role as a positive element, which has allowed the early approach to the disease”, points Ignacio Moncadahead of the Urology Service of the Sanitas La Zarzuela Hospital.

In addition to PSA, there are other biomarkers that guide the phase of the disease and the most convenient type of treatment:

• Proof 4Kscore: it’s a blood test which provides a patient-specific risk score for having aggressive prostate cancer. This test can provide information to improve decision-making before ordering a prostate biopsy.
• He prostate health index (phi): is a combination of the analysis of 3 molecules in blood with which a score is obtained; provides more information than what an elevated PSA level means.
• A urinalysis to determine the presence of PCA3, a prostate cancer gene that is expressed at a higher rate in prostate cancer tissue, but not in normal prostate tissue. It can help guide whether a patient with a previously negative prostate biopsy should undergo a repeat prostate biopsy.

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The study of these and other biological parameters does not exclude having to also do imaging tests to visualize the lesions, such as CT, bone scintigraphy, PET and “the multiparameter magnetic resonance (which defines the suspicious area), and then with the directed biopsy we already greatly refine the diagnosis”, adds Moncada.

Tumor grades

The gleason score is the one used to establish the stage of the tumor and is the result of microscopic analysis of the tissue sample removed by biopsy.

• Gleason 2-4: tumors of low grade (less aggressive).
• Gleason 5-7: tumors of intermediate grade.
• Gleason 8-10: tumores undifferentiated (more aggressive).

Most frequent treatments

There is a wide range of therapeutic possibilities, and urologists emphasize that the strategy against cancer must be always individualalthough age marks therapeutic aggressiveness. “In older patients, with low-grade tumors and a life expectancy limited to a few years, the active surveillance”, says the specialist from La Zarzuela, but if the patient is young, “the ideal is to eliminate the tumor, because the disease is usually of genetic origin and more aggressive”.

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Los most common treatments son:

Surgery: radical prostatectomy to remove the prostate gland. The most frequent consequences are urinary incontinence and impotence. Robotic surgery is associated with fewer side effects.

• External radiation therapy.
• brachytherapy: consists of placing needles in the prostate through which radiotherapy is administered. Its advantage is that the radiation is very localized and reaches the healthy tissues close to the tumor much less.
• Cryotherapy: the tumor is subjected to very cold temperatures administered through the gas that passes through needles inserted into the prostate.
• Hormonal treatment: it is a clinical castration and causes certain side effects such as hot flashes, sexual dysfunction, and osteoporosis
• Chemotherapy: is indicated for cancer of the metastatic prostate.

The weight of the inheritance

Age and obesity play in favor of prostate cancer in most men, but in a small group, which weight is genetics. Hereditary prostate cancer (5% of cases) can be suspected when:

• There are three or more first-degree prostate cancer patients.
• Hay 3 generations affected in the same branch of the family.
• Two or more close relatives diagnosed before the age of 55.
• A man’s risk of having a prostate tumor is two to three times higher when he has an affected first-degree relative.
• Men from families with hereditary breast and ovarian cancer, associated with mutations in the BRCA1 and BRCA2 genes.

guardians of the prostate

Café: and study in about 48,000 men found that those taking more than 3 cups a day reduced the risk of developing aggressive prostate cancer by 30%. The effect may respond to the content of the café in antioxidant and anti-inflammatory compounds.

tomato and watermelon: lycopene (a carotenoid present in these vegetables) inhibits the ability to form new blood vessels that feed the tumor. A investigation found reductions of up to 25% the risk of developing prostate cancer in men who had high levels of lycopene in their blood.

Sleep well: and epidemiological study points out that the men who sleep longer hours in a row have higher levels of melatonin that are associated with a 75% decrease in the risk of prostate cancer.

Physical activity: improves the general state of health and prevents obesity.

Protective sex?

Maintain an active sex life has been suggested as a good protective shield against prostate tumors, a myth that Ignacio Moncada refutes: “Sexual activity implies that the prostate work because it produces seminal fluid and the kept in good working orderbut there is no clear study that shows that the more sexual activity, the less prostate cancer (or even less benign hyperplasia)”.

Throughout the year, more than 29,000 men in Spain receive a diagnosis of prostate cancer and join the nearly 5 million who have the same disease in the world. Most will be cured or will live many yearsalthough the tumor does not disappear, but a minority of those affected will die (close to 6,000 in our country in the year 2021), and if they are known and more or less youthsthe impact is great because it makes true that “it can touch you”, and for example, now it is meets one year after the death, at the age of 61, of Javier ImbrodaMinister of Education and Sports of the Junta de Andalucía and former national basketball coach.